A phone call came into the help center from an older patient. She asks, “Which of my insurances is my primary insurance?”
She has been on her husband’s HMO for a long time. Recently she got a new job that offers health insurance, as well.
Discuss
What advice would you give the caller to find out how to tell which insurance would be her primary and why that matters. And, if she submitted a claim, should it be filed with multiple carriers?
Expert Solution Preview
Introduction:
As a medical professor, it is important to not only educate students on medical theories and practices, but also on practical aspects of the healthcare system. One such practicality is understanding health insurance and its complexities, including how to determine a primary insurance plan. In this scenario, an older patient has called into a help center seeking advice on which of her insurances is her primary insurance.
Answer:
The advice I would give the caller is to first contact both her husband’s HMO and her new job’s health insurance provider to ask which plan is considered the primary insurance. Each insurance plan defines primary insurance differently and may have different policies in place. For example, one plan may consider the spouse’s insurance to be primary, while the other may consider the new job’s insurance to be primary.
It is important for the patient to determine which insurance is primary because the primary insurance plan will be responsible for paying the majority of the patient’s medical bills. The secondary insurance plan will only cover any remaining costs that the primary insurance plan does not cover.
If the caller has already incurred medical expenses and needs to submit a claim, it is important that the claim is filed with both insurance carriers. This is known as coordination of benefits. The primary insurance plan will process the claim first and then the secondary insurance plan will process any remaining costs. It is important to note that the patient does not receive double payment, but rather the secondary insurance plan covers any remaining costs up to its coverage limits.
In conclusion, it is important for patients to understand the complexities of their health insurance plans and determine which plan is their primary insurance. The advice given to the caller was to contact both her husband’s HMO and her new job’s health insurance provider to determine which plan is primary and to submit a claim to both carriers if medical expenses have already been incurred.
